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Incisions

Kochers

Location/Direc tion
Oblique subscostal incision left or right

Description
Incision made obliquely in the epigastrium downward atleast 2 fingerbreadths below and parallel to the costal region or margin Incision in the epigastrium at the level of the xiphoid process then vertically downward to the level of the umbilicus

Advantage s
^Gives excellent exposure of the upper abdominal content ^Maximum postoperative strength ^Provides excellent exposure of upper abdominal content ^Easily executed ^Easily extended ^Easily closed ^Provides excellent exposure of the pelvic organs ^Quickly executed ^Extended easily ^Quickly used ^Allows maximum exposure of nearby organs according to the location ^Easily extended ^Gives firm

Disadvantage s
^External with difficulty ^Executed slowly ^Painful postoperatively

Uses
Right: ^Gall bladder and biliary tract surgery ^Liver surgery Left: ^Spleen surgery ^Gastric surgery

Synonym s
Subcostal

Upper midline (Vertical)

abdominal incision

Upper abdominal, vertical incision

^High incidence of wound dehiscence

^Rapid entry into the abdomen to control bleeding ulcer ^Gastric surgery ^Exploratory ^Pancreatic surgery ^Transverse colostomy

^Epigastric incision ^Upper median incision ^Vertical

Lower abdominal Midline incision

Lower abdominal, vertical incision

Incision made in the umbilicus and vertically extended downward in the midline to the suprapubic region

^Lacks strength

wound

^Pelvic laparotomy ^TAH-BSO ^Suprapubic prostatectomy ^Cystectomy ^Cystolithotomy ^CS ^Sigmoid colon operation Right upper: ^Gall bladder and biliary tract surgery ^Liver surgery Left Upper: ^Spleen surgery ^Gastric surgery ^Repair of hiatus hernia

^Suprapubi c incision ^Median suprapubic incision

Paramedian incision

Vertical incision that is confined to an area approximately 2 fingerbreaths to the right or left of the midline and maybe in the upper or lower

Incision is extended in a vertical direction parallel to & 2 fingers lateral to the midline rather

^Slowly executed and closed

^Right upper ^Left upper ^Right lower ^Left lower

abdomen

closure

Mcburneys incision

Oblique incision over the Mcburneys point in the RLQ

Inguinal incision

Oblique incision in the inguinal region

Horizontal Flank incision (Midline transverse)

Mid-abdominal incision that extends out into the flank

Incision is extended obliquely from just below the umbilicus through the Mcburneys point upward toward the right flank Incision is extended from the pubic tubercle one fingerbreadth above and parallel to the inguinal crease up to the anterior iliac crest Incision is made at the lateral border of the rectus sheath at the level of the umbilicus and is extended out to the flank

^Quickly executed and closed ^Allows a firm wound closure

^Difficult extend ^Gives exposure

to poor

Right Lower: ^Appendectomy ^Small bowel resection Left Lower: ^Sigmoid colon resection ^Hysterectomy Appendectomy

^Inguinal herniorrhaphy ^Excision of hydrocele of the cord

Gridiron incision

^Rapidly excuted and closed ^Easily extended ^Provides a secure wound ^Rapidly excuted and closed ^Easily extended ^Provides a secure wound

^Lumbar symphthectomy ^Nephrectomy ^Ureterolithotomy ^Inferior vena cava ligation ^Lumbar symphthectomy ^Nephrectomy ^Ureterolithotomy ^Inferior vena cava ligation Simple flank incision

Lumbotomy incision

Incision starts at the costovertebral angle and parallel to the 12th rib and extends forward and downward between iliac crest and the thorax

Thoracotomy Incision a. Right/Left Lateral posterothoracic Incision begins posteriorly inferior to the scapula and extends in oblique direction anteriorly over or between 2 ribs Incision is made from anterior midline or external border to the lateral mid-axillary line Left or right incision starts at point midway between xiphoid process and umbilicus and extends across the abdomento the 7th or 8th costal interspace and along interspace into the thorax Curved, transverse incision across the lower abdomen within the hairline of the pubis A curvilinear incision located below the umbilicus Cuvilinear incision 1 fingerbreadth ^Lung operation ^Anterior spinal fusion (thoracic vertebrae)

b.

Anterolateral approach

Causes minute postoperative difficulty as stability of the chest is concerned

Injury to intercostals neurovascular bundle may result to: ^Postop pain ^Severe hemorrhage

^Lung operation ^Heart operation a. Ligation of patent ductus arteriosus b. Mitral commissuretomy ^Esophagectomy ^Esophagastrectomy ^Esophagocardiomyo tomy (Hellers procedure)

Thoracoabdominal incision

Pfannenstiel Incision

Provides strong closure

Extended executed difficulty

and with

Infraumbilical Incision

^Pelvic laparotomy ^TAH-BSO ^CS ^Prostate surgery ^Urinary bladder surgery Umbilical hernia repair

Bikini incision

Miscellaneous incision a. Collarline

^Thyroid surgery ^Parathyroid surgery

Cuvilinear incision

b. c. d.

Coronal incision Limbak incision Elliptical

above the supraclavicular notch parallel to the lower insertions of the SCM muscle

Craniotomy Cataract extraction Radical mastectomy Mastoidectomy

Butterfly incision

Halstead incision

e.

Post-aural, endaural incision

f.

Cannine incision

fossa

Caldwell luc

g.

Gibson incision

Ureterolithotomy